How would you fix the healthcare system?

[jigger]

In the wake of the elections, there is a lot of talk on what direction the counrty will take. The healthcare system is what probably concerns us most, as medical students and prospective medical students.

 

It is definitely a complex issue, one that needs real attention if we are to provide the best service to our future patients. Putting politics and ideologies aside, what can we do to make the healthcare system better?

 

Let's focus on practical and pragmatic solutions!

[surgeondude]

It really depends on how you define better.

 

I hate to say it, but it seems that the major dilemma we face is whether to improve quality for most of improve access for all.

 

Ideally, these wouldn't be mutually exclusive, but it seems like they are with current limitation in budget and legislative options.

[kylamonkey]

I have to say that I think the NDP touched on an issue that I am most concerned about- the gap in care between urban and rural. often when this issue comes up I see that the proposed solution, time and time again, is to give bonuses to doctors/nurses willing to relocate. in my opinion, this just further increases the perception that living and working in these underserved areas is undesireable.

 

The NDP was the only party that adressed the issue of recruitment of students wanting to work in rural areas, and training focusing on encouraging students to choose rural care.

[fever]

I have to say that I think the NDP touched on an issue that I am most concerned about- the gap in care between urban and rural. often when this issue comes up I see that the proposed solution, time and time again, is to give bonuses to doctors/nurses willing to relocate. in my opinion, this just further increases the perception that living and working in these underserved areas is undesireable.

 

The NDP was the only party that adressed the issue of recruitment of students wanting to work in rural areas, and training focusing on encouraging students to choose rural care.

 

just how would you encourage these students to choose rural care?

[kylamonkey]

just how would you encourage these students to choose rural care?

 

I'm not an expert, just a student interested in the topic, but I do like what UWO is doing with requiring all students to participate in a rural elective. I'm sure there are lots of other methods too.

[vanillabear]

just how would you encourage these students to choose rural care?

 

iirc, Jack said something along the lines of "if you work in a rural area for X number of years, you get Y amount of your student debt paid by the government"...or something to that effect.

[NLengr]

I'm not an expert, just a student interested in the topic, but I do like what UWO is doing with requiring all students to participate in a rural elective. I'm sure there are lots of other methods too.

 

We have beendoing that for years but I don't know how much good it does.

[surgeondude]

iirc, Jack said something along the lines of "if you work in a rural area for X number of years, you get Y amount of your student debt paid by the government"...or something to that effect.

 

 

How is that any different than paying higher salaries to doctors who decide to work in rural communities.

 

The real problem is that we don't just need improvement in rural areas, but everywhere. Even in big cities, the quality is poor and waitlists take forever.

[The Ace of Spades]

I saw an article about a doctor that scheduled video-conferences with his patients from their homes. I realize that this is not effective for diagnosing a lot of illnesses, but it could allow a doctor to help many more patients in a day. If the problem is serious, the doctor could recommend that the patient comes in to the office at a later date.

 

Bottom line, our health-care delivery system is outdated and needs to be better integrated with technology.

[seeking1]

EFFICIENCY.

 

Lol, just kidding, this rarely happens. Last I checked, everyone in ER is a slave to the triage nurses anyways.

 

Some ways to "fix the system" include:

-change the ways doctors are paid for services (read into Andre Picard for this)(big deal, can't stick with FFS for everything)

- implement Family Health Teams, more family docs (this is already happening)

-role in more PAs, reduce resources going to NP programs

-attract nurses to stay here in Canada, as they get wooed away to the USA due to attractive career incentives

-institute a National Pharmacare Plan (not likely)

-form best practice guidelines (reduces long-term costs)

-I imagine some privitization occurs in here somewhere, I just haven't heard a convincing argument yet for a particular thing to get privatized (i.e. insurance? cancer care? diabetes?)

 

Please discuss, this is an important conversation.

[breeze]

I guess that the lack of responses to this thread shows that there really are no easy answers.

[A-Stark]

I guess that the lack of responses to this thread shows that there really are no easy answers.

 

Well, not really, just that there are a lot of different issues that cannot be "fixed" with a single overarching strategy. Sometimes it is a simple issue of funding and staffing - more acute care, rehab, and long-term care beds should be opened where there are significant bottlenecks. More OR time (not necessarily a lot more) should be available, and overall efforts should be made to improve wait times from the point of referral and diagnostic workup to specialist consultation.

 

Having said that, it's more a question of resources in a given area sufficient for demand. But when a smaller regional centre has only one, say, shoulder specialist, it becomes very hard to ensure reasonable wait times when every family doc in the area refers to him. That's why it becomes so important to make appropriate referrals. At the same time, patients should be willing to travel sometimes if it will expedite their care - in Nova Scotia, for example, we actually have a fair number of MRIs, but they are dispersed throughout the province, and patients can often obtain their scan more quickly by travelling to a different centre.

[fever]

Is it just me or did anyone else think that obama's original plan with the public option was genius.

 

I would think that something like that would work equally well for Canada.

[Robin Hood]

Now that Harper is has majority, what will be the future of healthcare?

[aaronjw]

Am i the only one who thinks prevenative health care over reactive health care is how we should function?

 

A lot of health issues are ones which could be aleviated or reduced by learning and addressing issues early on as opposed to reacting to them as they happen.

 

The initial cost may be high but i think problem is we think in terms of the present instead should be thinking of the future.

 

What savings could result from a healthier society?

 

Less insurance costs to companies freeing up additonal budget to invest in innovation, expansion or their workforce either through training or new hires

 

Healthier work force = less suck time and more productivity

 

Ohip costs saved freeing up money to offer better care to those with heath issues where prevenative medicine might not have worked (caners, digenitive issues, rare diseases (enhAnced diagnostic medicine), etc, etc

 

Just a few, i have more but am out of time right now

[NLengr]

However recently there is a big push on banning mixed martial arts (I don't actually watch), body checking and fights in hockey (again I don't care but some people do).

 

I'm still confused as to how we got into the whole banning body checking entirely from the sport of hockey debate?

 

Better implementation and management of body contact, better rules, better equipment, all of these would be reasonable ideas. But it seems like all of the sudden a bunch of people who have never played a game of hockey in their lives are screaming that body contact must be eliminated 100%. No other solution is acceptable or viable to these people.

 

That and nobody ever asked the players (either recreationally or professionally how they wanted to play the game).

[A-Stark]

Well, anything directed at someone's head is inexcusable. I don't think it's unreasonable to work to limit violence in sports, anymore than it's unreasonable to charge that the likes of ATVs should not be operated by minors.

[big_med]

Is it just me or did anyone else think that obama's original plan with the public option was genius.

 

I would think that something like that would work equally well for Canada.

 

 

I found that Obama original plan was very good as well.

 

As for whether or not it would work in Canada is another question. On a practical sense, there is no reason why it couldn't work, it would definitely reduce government costs while improving quality and innovation. But from a political standpoint, many may see it as the privatization of healtcare, which is a very sensitive issue.

 

Personally, I don't think that universal healthcare necessarily needs to be equated to 100% government run. There is a way for everyone to have health coverage without having it completely government run. As long as it is affordable for everyone to buy into a plan, and for those who can't there is a government safety net.

 

One of the best functioning aspects is the drug plan and that has partial private involvement

 

One of the biggest problems is that the government has to much control over the healthcare system. They are not just in charge of reimbursement, but they control healthcare at every level. For example a hospital can't expand without a politician saying that it is ok, which really limits the systems ability to adapt to changing needs of the population.

[A-Stark]

Personally, I don't think that universal healthcare necessarily needs to be equated to 100% government run. There is a way for everyone to have health coverage without having it completely government run. As long as it is affordable for everyone to buy into a plan, and for those who can't there is a government safety net.

 

Well, it isn't "government run", unless you're arguing that governments are involved in the direct management of hospitals or individual practices. What services will you be de-listing from provincial insurance?

 

One of the best functioning aspects is the drug plan and that has partial private involvement

 

The drug "plan" is a borderline disaster with patchwork fragmented coverage and significant inequities. Prices are edging further out of control on an annual basis - and drugs represent the fastest growing component of total spending.

 

One of the biggest problems is that the government has to much control over the healthcare system. They are not just in charge of reimbursement, but they control healthcare at every level. For example a hospital can't expand without a politician saying that it is ok, which really limits the systems ability to adapt to changing needs of the population.

 

This is so far off the mark I'm not sure how to address it. Fee schedules and salaries are negotiated with professional associations and unions. Administration occurs at the regional or local level almost everywhere (Alberta Health Services being an exception for the moment) and politicians are removed from any kind of routine decisions apart, perhaps, from provincial ministers of health.

[Guest copacetic]

007 the three biggest costs were hospitals ($45.4B/28.2% ), medications ($26.5B/16.5% ), and physicians ($21.5B/13.4% ).

 

The main problems facing healthcare in canada are timely accessibility, lack of support staff and resources and overall lack of health care services in the rural areas.

 

also while it is true that individual hospitals are corporations and run their own business, it is fallacy to say that there is no political involvement. appointment of hospital CEOs is essentially a political appointment. each hospital has a set budget granted by the government each year and is required by law to stay in the black. the only way to do this in the face of increasing costs is to cut services. in canada patients are essentially seen (in the economic sense) as an expense, and this is because that there is a set budget to begin with. In the united states patients are seen as a source of revenue with each procedure and each patient seen generating income.

 

im not claiming that any one system is better than the other. the only thing i will say however is that if we as canadians continue to hold on to our beloved system of universal health insurance, then we must face the reality that health care costs will continue to skyrocket even as accessibility decreases. the easiest thing is to throw more money at the system but provinces already spend close to half or more of every tax dollar on health care. education is the other big expense at the provincial level. thus inevitably when we add to health care, usually this will affect education spending negatively.

 

the pot is finite. I honestly believe that the burden of increasing costs will threaten the financial security of this country, and i see a role for privately funded health resources and facilities. the canada health act does not forbid this. what it does is prevent patients from being charged for medically necessary procedures.

 

moreover the health care administration is overly bloated. the number of midlevel administrators has exploded and its questionable as to whether or not the services they provide are entirely worth their cost. moreover often times you will see health care personal working overtime and making double or triple their normal salary, when it would have been cheaper to just hire a new staff member.

[A-Stark]

We already have "privately funded health resources and facilities" which is why physicians have overhead. Otherwise, there has been some moves (especially in BC) to move to "activity-based" funding of hospitals which would replace block funding in favour of funding per procedure/treatment. Hard to say that this would ever actually reduce costs, but a blending funding model might be most appropriate.

 

Note further that it's only in Ontario that hospitals have individual boards and CEOs (who are appointed by said boards, not by the government). Elsewhere regional health authorities are the norm, and in Nova Scotia formerly independent hospitals continue to maintain their own charitable foundations.

[NLengr]

Well, anything directed at someone's head is inexcusable. I don't think it's unreasonable to work to limit violence in sports, anymore than it's unreasonable to charge that the likes of ATVs should not be operated by minors.

 

Intent to injure hitting and head shots are definitely inexcusable and should be punished. But it's not like the ONLY type of body contact in the sport is intent to injure and head shots. It's just that these few hits get media attention and therefore are picked up by non players/non fans, who assume every hit is like this.

[Guest copacetic]

We already have "privately funded health resources and facilities" which is why physicians have overhead. Otherwise, there has been some moves (especially in BC) to move to "activity-based" funding of hospitals which would replace block funding in favour of funding per procedure/treatment. Hard to say that this would ever actually reduce costs, but a blending funding model might be most appropriate.

 

Note further that it's only in Ontario that hospitals have individual boards and CEOs (who are appointed by said boards, not by the government). Elsewhere regional health authorities are the norm, and in Nova Scotia formerly independent hospitals continue to maintain their own charitable foundations.

 

to say that We already have "privately funded health resources and facilities" and that this why physicians have overhead is not entirely correct. what we have is a mixed model system (like most countries) with 70% of health care cost funded by the government and 30% by private enterprise (stuff like dental and drug coverage). We have a largely publicly funded health insurance system with services delivered by private individuals who use public funds/billings to cover overhead. to say that because physicians have overhead and thus the system is funded privately is inaccurate.

[aaronjw]

I don't think discussions relate to sports, extra circulars or every day life events (driving, walking across the street, bike riding, etc) *should be brought into the discussion on the topic of how to fix the health care system in Canada.

 

These EC injuries are not the majority of health issues (correct me if I'm wrong - I have no stats to back up my thoughts on this) and outside of living in a bubble you'll not prevent them from happening - crap happens.

 

When I talk about preventative medicine I'm more or less talking about the routine stuff that often does not get reported on early on because we don't GO to the DR. If we're required to have full blood panel and imaging done once or twice a year (yes, I'm making a trillion dollar joke here lol) then potentially we're going to spot problems as they arise or before they arise thus treatment for minor issues can ensue before they turn into much larger issues .

 

I guess what I am talking about is a more holistic approach to medicine where many factors including nutrition (Canada's food guide is a joke at best, btw) play a huge role in our health.

 

Most of of the issues i see amongst my own family and that of my friends are issues which I *think* could have been prevented had they just went to the damn Doctor instead of waiting until that "tired and fatigued feeling" got so bad that it turned into a blown thyroid which led to low testosterone which led to weight gain which led to depression which led to more weight gain, time off at work, etc. Its a vicious cycle where one simple issue left untreated could turn into a major issue or series of issues.

 

I doubt what I'm saying has any practical application but these are the things I see from the people in my life which make me think the things I do.

[NLengr]

http://www.cbc.ca/news/health/story/2011/05/09/bc-insite-supreme-court-canada.html

 

That's kinda on topic. My favorite line out of the article:

 

"Supporters, including the province, say a body of peer-reviewed studies has proven Insite prevents overdose deaths, reduces the spread of HIV and hepatitis, and curbs crime and open drug use.

 

But the federal government rejects that evidence, arguing the facility fosters addiction and runs counter to its tough-on-crime agenda."

 

So what I have learned is evidence based medicine is for chumps and decisions should be based on ideology. That's the real way to make health care decisions.